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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > nocturnal bladder control
Expert: Arthur Goldstein, M.D.
Date: 8/11/2008
Subject: nocturnal bladder control
Question
I am seventy five and have had the problem of nocturnal bladder control for a number of years. That is, I wake several times a night because of the need to urinate. This leads to a very weak flow before I can resume sleeping. That is, I have the urge even though the bladder is relatively empty. I am under treatment by a urologist for renal colic and for possible prostrate problems. However, I am curious in that I can go for long periods during the day, even with a large fluid intake, without feeling the need to urinate until I am in a convenient location, like just arriving home. The flow is then quite strong, suggesting the bladder was nearly full. Is there some reason why the nocturnal urge is so different to the diurnal one?
Answer
Denis, nocturia is a very common and early symptom of prostatic enlargement. In addition to benign prostatic hypertrophy (BPH) & prostate cancer, there are many other predisposing factors. These include sleep apnea, snoring, & obesity. Certain medication (such as taking diuretics before sleep) will also cause nocturia. It is important not to take caffeine containing products (such as coffee, tea, sodas, etc.) in the evening as these may also cause a diuretic effect. Antidiuretic hormone (ADH) is normally produced in greater amounts at night. In some people, there is a reversal of the normal circadial release of ADH which can also predispose to nocturia.
The force of the urinary stream is often slower at night and associated with hesitancy compared to the daytime. This is due to the fact that when asleep, the bladder can become fuller than during the day. The overstretched bladder will not contract as strongly and hence the flow is weaker. Double voiding at night is helpful as one cannot totally rely on the feeling of having emptied completely. In other words, urinate, wait approximately one minute and then try again.
In addition to correcting any of the potential etiologies listed above, the use of alpha blockers (such as Hytrin, Cardura, Flomax, & Uroxatral) or the prostate shrinking medications Proscar & Avodart often relieve nocturia if of prostatic origin. DDAVP (synthetic ADH) nasal spray or tablets used before sleep can be tried for those with reversal of the normal circadian production. Melatonin has also been used with some success for nocturia. As all of these medications have potential side effects, they should be taken only after consultation with your physician. Good luck.
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